Prior Authorization (Part C)
Prior Authorization is a process that is used by your doctor to get you extra care or services. The process is also called a referral request.
Your doctor or Primary Care Physician (PCP) will send in the paper work that is needed to get the Prior Authorization. If you do not have a prior authorization, the cost for the services may not be paid by Health Net.
Please read the Member Handbook to see which services need prior authorization. Some services do not require Prior Authorization, they include:
- Emergency Care,
- Urgent Care,
- Preventive services,
- Family planning services,
- Out of area renal dialysis services,
- Basic prenatal care,
- Sexually transmitted disease services, and
- HIV testing
Health Net Cal MediConnect will notify your doctor when the Prior Authorization services are approved. Health Net Cal MediConnect will send you a letter to let you know if an Authorization was not approved. The letter will include your appeal rights.
Health Net Cal MediConnect will usually decide within 14 days or will ask you for more time to make a decision. If you have a very urgent need, you or your doctor can ask Health Net Cal MediConnect to speed up the review. This is called an expedited decision. The review may be done faster if you think that there could be very serious harm to your health or you may lose maximum function. To request an expedited decision go to contact us.
Your doctor needs to send a request for a Prior Authorization before you can ask Health Net Cal MediConnect to speed up their decision.
If your Prior Authorization request has been denied by Health Net Cal MediConnect, you have the right to appeal this decision.
For more information about coverage determinations and prior authorization, you may refer to chapter 9 of the Member Handbook or you may contact Member Services.
Health Net Community Solutions, Inc.
Monday through Friday, 8:00 a.m. to 5:00 p.m.
Status of Authorization: 1-800-977-7282
Fax: 1-800-793-4473; 1-800-672-2135
Hours are from 8 a.m. to 8 p.m., Monday through Friday. After hours, on weekends and on holidays, you can leave a message. Your call will be returned within the next business day.